UMEM Educational Pearls

Category: EMS

Title: What are the barriers to 911 being able to direct hands only CPR instructions to callers?

Keywords: Hands only CPR, bystander CPR, directions (PubMed Search)

Posted: 8/16/2023 by Jennifer Guyther, MD (Updated: 5/25/2024)
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Bystander CPR increases out-of-hospital CPR survival and direction by 911 telecommunicators increases the frequency of bystander CPR.  The majority of 911 centers use Medical Priority Dispatch System which walks 911 telecommunicators through a series of questions that give different instructions based on the caller's answers.  Studies have shown out-of-hospital cardiac arrests are only recognized between 79-92% of the time and telecommunicator instructions for CPR can take between 176-285 seconds.

This study reviewed recorded 911 calls of patients who were found to be in cardiac arrest. Calls where the caller was not with the patient and confirmed overdoses were some of the call types that were excluded.

Out of 65 reviewed calls, 28% were not recognized during the actual call.  When they were reviewed, 8/18 of the calls were deemed to be recognizable.  Themes that were noted were: incomplete or delayed recognition assessment (ie uncertainty in breathing), communication gaps (callers were confused with instructions or questions), caller emotional distress, delayed repositioning for chest compressions, non essential questions and assessments, and caller refusal/hesitation or inability to act.

Bottom line: In addition to bystander CPR training, education on the process and questions involved in calling 911 could be helpful in an emergency.  


Missel et al.  Barriers to the Initiation of Telecommunicator-CPR during 911 Out-of-Hospital Cardiac Arrest Calls: A Qualitative Study.  2023.  Prehospital Emergency Care.